Diabetes control through an educational intervention

Objective: We evaluated the effect of an educational intervention administered to patients or/and physicians on the reduction in HbA1c and achieving diabetic control in a high-risk primarily Black inner-city population. Methods: The study was designed as a four-arm randomized clinical trial where an educational program on diabetes was offered to physicians only, patients only, and both physicians and their patients, while the fourth arm did not receive any instruction. We built regression models at 24 months of follow-up to assess the likelihood of reaching glycemic goal as well as to measure the absolute reduction in HbA_1c controlling for arm assignment, insulin use, race, age, sex, smoking, insulin use, and having achieved blood pressure control. Results: Between April 2005 and July 2007, there were 823 patients randomized into the study. In multivariate analyses, the intervention group in which only patients received education showed a trend toward achieving a significant mean reduction in HbA_1c with 49% (P=.06) higher odds of reaching glycemic control and .12 (P=.06) greater absolute percentage point drop in HbA_1c compared to the no education group. Conclusion: Although our study reports positive results, it warrants a special emphasis on the behavior of the patient. Study results bring attention to disease management programs such as peer support networks that empower the patients that shift some of the responsibility to them.